TY - JOUR
T1 - Risk factors of late lesion growth after acute ischemic stroke treatment
AU - Konduri, Praneeta
AU - Bucker, Amber
AU - Boers, Anna
AU - Dutra, Bruna
AU - Samuels, Noor
AU - Treurniet, Kilian
AU - Berkhemer, Olvert
AU - Yoo, Albert
AU - van Zwam, Wim
AU - van Oostenbrugge, Robert
AU - van der Lugt, Aad
AU - Dippel, Diederik
AU - Roos, Yvo
AU - the MR CLEAN Trial Investigators (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands)
AU - Bot, Joost
AU - Majoie, Charles
AU - Marquering, Henk
N1 - Funding Information: MR CLEAN is partly funded by the Dutch Heart Foundation (2008 T030). MR CLEAN is also funded by unrestricted grants from: AngioCare BV, Covidien/EV3, MEDAC Gmbh/LAMEPRO, Penumbra Inc., and Concentric Medical/TOP Medical BV. The study is designed, conducted, analyzed, and interpreted by the investigators independently of all. This sub-study is also funded by INSIST ( www.insist-h2020.eu ): a European Union's Horizon 2020 research and innovation program (grant agreement number: 777072). ® Funding Information: PK is funded by INSIST ( www.insist-h2020.eu ): a European Union's Horizon 2020 research and innovation program (grant agreement number: 777072). ABo is a shareholder of Nico.Lab. AY reports grants from Cerenovus Neurovascular, Medtronic, Stryker, Penumbra, and Genentech for investigator-initiated studies; funds from Stryker, Cerenovus Neurovascular and Penumbra (core imaging lab activities) and Genentech (consultation); and declares to have equity ownership from Insera Therapeutics. WZ reports speaker fees from Stryker and Cerenovus (paid to the institution). AL and DD report funds from the Cerenovus Neurovascular, Dutch Heart Foundation, Brain Foundation Netherlands, Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants paid to the institution from AngioCare BV, Covidien/EV3, MEDAC Gmbh/LAMEPRO, PenumbraInc., Top Medical/Concentric, Stryker, Stryker European Operations BV, Medtronic, Thrombolytic Science and LLC for research. AL further reports grants paid to the institution from the Siemens Healthineers, GE Healthcare and Philips Healthcare. YR is a shareholder at Nico-Lab. CM reports grants from European Commission, during the conduct of the study; grants from CVON/Dutch Heart Foundation, grants from TWIN Foundation, grants from Stryker, outside the submitted work; and owns stock in Nico.lab. HM is a Co-founder and shareholder of Nico.lab. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher Copyright: Copyright © 2022 Konduri, Bucker, Boers, Dutra, Samuels, Treurniet, Berkhemer, Yoo, van Zwam, van Oostenbrugge, van der Lugt, Dippel, Roos, Bot, Majoie, Marquering and the MR CLEAN Trial Investigators (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands).
PY - 2022/10/5
Y1 - 2022/10/5
N2 - Background: Even days after treatment of acute ischemic stroke due to a large vessel occlusion, the infarct lesion continues to grow. This late, subacute growth is associated with unfavorable functional outcome. In this study, we aim to identify patient characteristics that are risk factors of late, subacute lesion growth. Methods: Patients from the MR CLEAN trial cohort with good quality 24 h and 1-week follow up non-contrast CT scans were included. Late Lesion growth was defined as the difference between the ischemic lesion volume assessed after 1-week and 24-h. To identify risk factors, patient characteristics associated with lesion growth (categorized in quartiles) in univariable ordinal analysis (p < 0.1) were included in a multivariable ordinal regression model. Results: In the 226 patients that were included, the median lesion growth was 22 (IQR 10–45) ml. In the multivariable model, lower collateral capacity [aOR: 0.62 (95% CI: 0.44–0.87); p = 0.01], longer time to treatment [aOR: 1.04 (1–1.08); p = 0.04], unsuccessful recanalization [aOR: 0.57 (95% CI: 0.34–0.97); p = 0.04], and larger midline shift [aOR: 1.18 (95% CI: 1.02–1.36); p = 0.02] were associated with late lesion growth. Conclusion: Late, subacute, lesion growth occurring between 1 day and 1 week after ischemic stroke treatment is influenced by lower collateral capacity, longer time to treatment, unsuccessful recanalization, and larger midline shift. Notably, these risk factors are similar to the risk factors of acute lesion growth, suggesting that understanding and minimizing the effects of the predictors for late lesion growth could be beneficial to mitigate the effects of ischemia.
AB - Background: Even days after treatment of acute ischemic stroke due to a large vessel occlusion, the infarct lesion continues to grow. This late, subacute growth is associated with unfavorable functional outcome. In this study, we aim to identify patient characteristics that are risk factors of late, subacute lesion growth. Methods: Patients from the MR CLEAN trial cohort with good quality 24 h and 1-week follow up non-contrast CT scans were included. Late Lesion growth was defined as the difference between the ischemic lesion volume assessed after 1-week and 24-h. To identify risk factors, patient characteristics associated with lesion growth (categorized in quartiles) in univariable ordinal analysis (p < 0.1) were included in a multivariable ordinal regression model. Results: In the 226 patients that were included, the median lesion growth was 22 (IQR 10–45) ml. In the multivariable model, lower collateral capacity [aOR: 0.62 (95% CI: 0.44–0.87); p = 0.01], longer time to treatment [aOR: 1.04 (1–1.08); p = 0.04], unsuccessful recanalization [aOR: 0.57 (95% CI: 0.34–0.97); p = 0.04], and larger midline shift [aOR: 1.18 (95% CI: 1.02–1.36); p = 0.02] were associated with late lesion growth. Conclusion: Late, subacute, lesion growth occurring between 1 day and 1 week after ischemic stroke treatment is influenced by lower collateral capacity, longer time to treatment, unsuccessful recanalization, and larger midline shift. Notably, these risk factors are similar to the risk factors of acute lesion growth, suggesting that understanding and minimizing the effects of the predictors for late lesion growth could be beneficial to mitigate the effects of ischemia.
KW - acute ischemic stroke
KW - infarct growth
KW - lesion evolution
KW - post-treatment
KW - predictors
KW - risk factors
KW - subacute
UR - http://www.scopus.com/inward/record.url?scp=85140774785&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fneur.2022.977608
DO - https://doi.org/10.3389/fneur.2022.977608
M3 - Article
C2 - 36277932
SN - 1664-2295
VL - 13
JO - Frontiers in Neurology
JF - Frontiers in Neurology
M1 - 977608
ER -